Catheter mapping and ablation during pregnancy.

A substantial number of pregnant women at some point experience cardiac arrhythmia, which is mostly treated by antiarrhythmic medication. In some instances, arrhythmias can be drug-resistant and pose a relevant risk to both mother and unborn child as they can result in hemodynamic compromise. In recent years, invasive electrophysiology procedures have been carried out with ever reducing exposure to ionising radiation, and multiple techniques have been established to achieve ZERO exposure. Of course, these techniques should all be applied when contemplating an invasive mapping and ablation procedure during pregnancy. The role of the cardio-obstetrics team in planning and performing such procedures is paramount. Careful assessment of the pregnant mother and her unborn child is mandatory. Only with good preparation is a complete understanding of both cardiac anatomy and physiology achievable, which is a pre-requisite of a successful ablation outcome. Various aspects of the ablation procedure itself are discussed and evaluated from the perspective of all team members involved, including the obstetrician, the anaesthetist and the electrophysiologist. This review aims to inform the reader about the techniques available and reports on the published outcomes for ablations during pregnancy in the last decade.

Ductal closure in infants under 6 kg including premature infants using AmplatzerTM duct occluder type two additional sizes: a single-centre experience in South Africa.

BACKGROUND: This is a report on percutaneous closure of patent ductus arteriosus (PDA) using Amplatzer Duct Occluder type two additional sizes (ADO II AS) in patients under 6 kg. METHODS: Prospective data were collected and a review of Patients' records was conducted. Demographics, and angiographic and clinical outcomes are reported in this article. RESULTS: During the period June 2011 to June 2017, of the 92 patients who underwent closure of the PDA using the ADO II AS device, 59 were under 6 kg. The median weight of the cohort at closure was 3.6 kg (range: 900 g - 5.8 kg). The median ductal diameter was 1.9 mm (range: 1.0-3.4 mm). Three embolisations in the cohort were all retrieved percutaneously. Two PDAs were closed percutaneously and one surgically. Four premature infants required blood transfusions. The closure rate was 96.6% before discharge. CONCLUSIONS: PDA closure using ADO II AS in small infants is feasible, effective and has few complications.

Monocentric experience of leadless pacing with focus on challenging cases for conventional pacemaker.

AIM: Leadless cardiac pacemaker has been developed to reduce complications related to cardiac pacing and is considered as an alternative to conventional pacemaker although safety and efficacy data in clinical practice are limited. The purpose of this study was to investigate the safety and efficacy profile of Micra Transcatheter Pacing System (TPS) used in daily clinical activity with a focus on challenging cases for conventional pacing. METHODS: A total of 66 patients (46 men, 79.1 ± 9.7 years) having a Class I or II indication for ventricular pacing underwent a Micra TPS implant procedure. All patients were enrolled in a prospective registry. Follow-up visits were scheduled at discharge and after 1, 3, 6 and 12 months. RESULTS: Primary indication for pacing was third degree atrioventricular block (30.3%), sinus node dysfunction (21.2%) or permanent atrial fibrillation with bradycardia (45.5%). The device was successfully implanted in 65 patients (98.5%). During follow-up of 10.4 ± 6.1 months (range 1-23 months), electrical measurements remained stable. Mean pacing capture threshold, pacing impedance and R-wave sensing were respectively 0.57 ± 0.32 V, 580 ± 103 Ohms, 10.62 ± 4.36 mV at the last follow-up. One major (loss of function) and three minor adverse events occurred. Pericardial effusion, dislodgement, device related infection or pacemaker syndrome were not observed. Micra TPS implantation was straightforward for patients with congenital or acquired cardiac and/or vascular abnormalities, previous tricuspid surgery and after heart transplantation. CONCLUSION: Our experience confirms that implantation of Micra is safe and efficient in a real world population including patients who present a challenging condition for conventional pacing.

Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa.

BACKGROUND: Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. METHODS: Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. RESULTS: From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1-454 months) and the median weight was 8.5 kg (range 2.5-78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12-100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1-7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. CONCLUSION: The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients.